High-Sensitivity Cardiac Troponin Concentration and Risk of First-Ever Cardiovascular Outcomes In 154,052 Participants

Overview

Journal J Am Coll Cardiol

Specialty Cardiology & Vascular Diseases

Date 2017 Jul 29

PMID 28750699

Citations 103

Authors

Peter Willeit

Paul Welsh

Jonathan D W Evans

Lena Tschiderer

Charles Boachie

J Wouter Jukema

Ian Ford

Stella Trompet

David J Stott

Patricia M Kearney

Simon P Mooijaart

Stefan Kiechl

Emanuele Di Angelantonio

Naveed Sattar

Affiliations

Soon will be listed here.

Abstract

Background: High-sensitivity assays can quantify cardiac troponins I and T (hs-cTnI, hs-cTnT) in individuals with no clinically manifest myocardial injury.

Objectives: The goal of this study was to assess associations of cardiac troponin concentration with cardiovascular disease (CVD) outcomes in primary prevention studies.

Methods: A search was conducted of PubMed, Web of Science, and EMBASE for prospective studies published up to September 2016, reporting on associations of cardiac troponin concentration with first-ever CVD outcomes (i.e., coronary heart disease [CHD], stroke, or the combination of both). Study-specific estimates, adjusted for conventional risk factors, were extracted by 2 independent reviewers, supplemented with de novo data from PROSPER (Pravastatin in Elderly Individuals at Risk of Vascular Disease Study), then pooled by using random effects meta-analysis.

Results: A total of 28 relevant studies were identified involving 154,052 participants. Cardiac troponin was detectable in 80.0% (hs-cTnI: 82.6%; hs-cTnT: 69.7%). In PROSPER, positive associations of log-linear shape were observed between hs-cTnT and CVD outcomes. In the meta-analysis, the relative risks comparing the top versus the bottom troponin third were 1.43 (95% confidence interval [CI]: 1.31 to 1.56) for CVD (11,763 events), 1.67 (95% CI: 1.50 to 1.86) for fatal CVD (7,775 events), 1.59 (95% CI: 1.38 to 1.83) for CHD (7,061 events), and 1.35 (95% CI: 1.23 to 1.48) for stroke (2,526 events). For fatal CVD, associations were stronger in North American studies (p = 0.010) and those measuring hs-cTnT rather than hs-cTnI (p = 0.027).

Conclusions: In the general population, high cardiac troponin concentration within the normal range is associated with increased CVD risk. This association is independent of conventional risk factors, strongest for fatal CVD, and applies to both CHD and stroke.

Citing Articles

Review of Literature and Recommended Procedures for Management of Unusual Cases of False Positive Troponin Tests.

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Influence of Sex and Cardiometabolic Risk Factors on the High-Sensitivity Cardiac Troponins at the Concentrations Used as the Thresholds for Cardiovascular Risk Stratification in a Presumably Healthy Polish Population.

Bergmann K, Stefanska A, Kubica J, Krintus M, Panteghini M J Clin Med. 2024; 13(23).

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Cronin M, Neiroukh D, Lowery A, Wijns W, Kerin M, Keane M Int J Cardiol Heart Vasc. 2024; 55:101522.

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References

Nordenskjold A, Ahlstrom H, Eggers K, Frobert O, Jaffe A, Venge P . Short- and long-term individual variation in cardiac troponin in patients with stable coronary artery disease. Clin Chem. 2012; 59(2):401-9. DOI: 10.1373/clinchem.2012.191700. View

Klinkenberg L, van Dijk J, Tan F, van Loon L, van Dieijen-Visser M, Meex S . Circulating cardiac troponin T exhibits a diurnal rhythm. J Am Coll Cardiol. 2014; 63(17):1788-95. DOI: 10.1016/j.jacc.2014.01.040. View

McCarthy C, Yousuf O, Alonso A, Selvin E, Calkins H, McEvoy J . High-Sensitivity Troponin as a Biomarker in Heart Rhythm Disease. Am J Cardiol. 2017; 119(9):1407-1413. PMC: 5776707. DOI: 10.1016/j.amjcard.2017.01.032. View

McEvoy J, Chen Y, Ndumele C, Solomon S, Nambi V, Ballantyne C . Six-Year Change in High-Sensitivity Cardiac Troponin T and Risk of Subsequent Coronary Heart Disease, Heart Failure, and Death. JAMA Cardiol. 2016; 1(5):519-28. PMC: 5084093. DOI: 10.1001/jamacardio.2016.0765. View

deFilippi C, de Lemos J, Christenson R, Gottdiener J, Kop W, Zhan M . Association of serial measures of cardiac troponin T using a sensitive assay with incident heart failure and cardiovascular mortality in older adults. JAMA. 2010; 304(22):2494-502. PMC: 3559101. DOI: 10.1001/jama.2010.1708. View

Ford I, Shah A, Zhang R, McAllister D, Strachan F, Caslake M . High-Sensitivity Cardiac Troponin, Statin Therapy, and Risk of Coronary Heart Disease. J Am Coll Cardiol. 2016; 68(25):2719-2728. PMC: 5176330. DOI: 10.1016/j.jacc.2016.10.020. View

Higgins J, Thompson S . Controlling the risk of spurious findings from meta-regression. Stat Med. 2004; 23(11):1663-82. DOI: 10.1002/sim.1752. View

Scheven L, de Jong P, Hillege H, Lambers Heerspink H, van Pelt L, Kootstra J . High-sensitive troponin T and N-terminal pro-B type natriuretic peptide are associated with cardiovascular events despite the cross-sectional association with albuminuria and glomerular filtration rate. Eur Heart J. 2012; 33(18):2272-81. DOI: 10.1093/eurheartj/ehs163. View

Saunders J, Nambi V, de Lemos J, Chambless L, Virani S, Boerwinkle E . Cardiac troponin T measured by a highly sensitive assay predicts coronary heart disease, heart failure, and mortality in the Atherosclerosis Risk in Communities Study. Circulation. 2011; 123(13):1367-76. PMC: 3072024. DOI: 10.1161/CIRCULATIONAHA.110.005264. View

10.

Thorsteinsdottir I, Aspelund T, Gudmundsson E, Eiriksdottir G, Harris T, Launer L . High-Sensitivity Cardiac Troponin I Is a Strong Predictor of Cardiovascular Events and Mortality in the AGES-Reykjavik Community-Based Cohort of Older Individuals. Clin Chem. 2016; 62(4):623-30. PMC: 5943042. DOI: 10.1373/clinchem.2015.250811. View

11.

Pencina M, DAgostino Sr R, Steyerberg E . Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers. Stat Med. 2011; 30(1):11-21. PMC: 3341973. DOI: 10.1002/sim.4085. View

12.

Omland T, de Lemos J, Holmen O, Dalen H, Saltyte Benth J, Nygard S . Impact of sex on the prognostic value of high-sensitivity cardiac troponin I in the general population: the HUNT study. Clin Chem. 2015; 61(4):646-56. DOI: 10.1373/clinchem.2014.234369. View

13.

Eggers K, Al-Shakarchi J, Berglund L, Lindahl B, Siegbahn A, Wallentin L . High-sensitive cardiac troponin T and its relations to cardiovascular risk factors, morbidity, and mortality in elderly men. Am Heart J. 2013; 166(3):541-8. DOI: 10.1016/j.ahj.2013.07.004. View

14.

Blankenberg S, Salomaa V, Makarova N, Ojeda F, Wild P, Lackner K . Troponin I and cardiovascular risk prediction in the general population: the BiomarCaRE consortium. Eur Heart J. 2016; 37(30):2428-37. PMC: 4982535. DOI: 10.1093/eurheartj/ehw172. View

15.

Zeller T, Tunstall-Pedoe H, Saarela O, Ojeda F, Schnabel R, Tuovinen T . High population prevalence of cardiac troponin I measured by a high-sensitivity assay and cardiovascular risk estimation: the MORGAM Biomarker Project Scottish Cohort. Eur Heart J. 2013; 35(5):271-81. DOI: 10.1093/eurheartj/eht406. View

16.

Oluleye O, Folsom A, Nambi V, Lutsey P, Ballantyne C . Troponin T, B-type natriuretic peptide, C-reactive protein, and cause-specific mortality. Ann Epidemiol. 2012; 23(2):66-73. PMC: 3543509. DOI: 10.1016/j.annepidem.2012.11.004. View

17.

Everett B, Zeller T, Glynn R, Ridker P, Blankenberg S . High-sensitivity cardiac troponin I and B-type natriuretic Peptide as predictors of vascular events in primary prevention: impact of statin therapy. Circulation. 2015; 131(21):1851-60. PMC: 4444427. DOI: 10.1161/CIRCULATIONAHA.114.014522. View

18.

Pastormerlo L, Agazio A, Benelli E, Gabutti A, Poletti R, Prontera C . Usefulness of High-Sensitive Troponin Elevation After Effort Stress to Unveil Vulnerable Myocardium in Patients With Heart Failure. Am J Cardiol. 2015; 116(4):567-72. DOI: 10.1016/j.amjcard.2015.05.017. View

19.

Eggers K, Venge P, Lindahl B, Lind L . Cardiac troponin I levels measured with a high-sensitive assay increase over time and are strong predictors of mortality in an elderly population. J Am Coll Cardiol. 2013; 61(18):1906-13. DOI: 10.1016/j.jacc.2012.12.048. View

20.

Danesh J, Collins R, Appleby P, Peto R . Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA. 1998; 279(18):1477-82. DOI: 10.1001/jama.279.18.1477. View